Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health


Epidemiology and Biostatistics

First Advisor

Dr. Steven Browning

Second Advisor

Dr. Glen P. Mays


Health services research and public health services and systems research in the past have contributed to a strong foundation of evidence-based progress in organizing, financing, and delivering medical care and public health strategies across the United States. The purpose of this dissertation was to examine disparities in public health systems and in the delivery of population health services in communities served by these systems using nationally representative data from the National Longitudinal Survey of Local Public Health Systems (1998, 2006, 2012, and 2014).

Data from the 1998 cohort of 497 local health jurisdictions serving at least 100,000 residents, and from the 2014 expanded cohort of 546 local health jurisdictions serving less than 100,000 residents were used to conduct three studies. The first study “Local Public Health Systems and the burden of major heart diseases: A longitudinal analysis using National Longitudinal Survey of Local Public Health System” shows that stroke related mortality rate decreases over time in communities with increasing number of recommended population health activities. The second study “Rural Urban Differences in Recommended Population Health Activities and Organization of Public Health Delivery System Capital” shows that the urban communities with a centralized jurisdiction enjoy a greater availability of population health activities and a greater likelihood of being in a comprehensive population health system capital than rural non-centralized communities. The third study “Can comprehensive public health system determine the overall perceived effectiveness of public health activities and health status of a community?” shows a gradient relationship between public health systems composition and the ratings of perceived overall community health status and perceived effectiveness of the population health activities in communities where the most favorable ratings were observed in communities with comprehensive public health systems in comparison to conventional and limited public health systems.

Digital Object Identifier (DOI)